Digital health systems have grown in a fragmented manner in many countries. One vaccination program, another for HIV, another for maternal health, each built independently, often by different partners, on isolated platforms that cannot easily communicate with each other. Healthcare workers re-enter the same information more than once. Ministries struggle to get a complete picture of their own healthcare system, and each new investment adds another disjointed piece rather than strengthening the entire infrastructure.
The Open Health Stack Software Foundation (OHS-SF), newly launched by the Linux Foundation with support from WHO, Google and a global coalition of health and technology organizations, aims to help address this problem. WHO will help ensure that the Foundation’s work remains aligned with WHO norms, standards and country needs.
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Where Open Health Stack came from
The Foundation builds on a collaboration that began in 2020 when WHO recognized a practical problem: its SMART guidelines and other quality-assured clinical and public health recommendations and standards needed to be usable in real digital health systems, not just published as documents. WHO and Google have signed a memorandum of understanding to develop open source software code to make it easier for countries to adopt WHO guidelines using common interoperability standards such as HL7 FHIR.
This collaboration became Open Health Stack, launched in 2023, and with it grew a larger community of developers, implementers, health ministries, and technical partners. Millions of people in countries across sub-Saharan Africa, South Asia and Southeast Asia are now covered by health services built on Open Health Stack tools, from national digital record systems to community health worker platforms.
To ensure that these tools continue to serve the entire global health community rather than a single organization, Google is making the Open Health Stack code and resources available to a new, independent foundation hosted by the Linux Foundation.
Dr. Michael Howell, Chief Health Officer at Google, said: “Open Health Stack is a great example of an open, transparent and verifiable infrastructure that helps build truly trustworthy AI in healthcare. We are proud to contribute Open Health Stack to the Linux Foundation, ensuring that developers can build digital tools that clinicians and healthcare professionals can rely on, based on accessible, common standards. By collaborating with the entire community, together we can create an ecosystem focused on access to healthcare Health care and innovation focused.”
Based on open standards that the WHO already recommends
The Foundation’s work is based on the same standards that the WHO uses in its normative guidelines: HL7 FHIR for the exchange of health data and international terminologies such as the International Classification of Diseases (ICD), so that a diagnosis or service recorded in one system means the same in another system. The Open Health Stack tools are designed to work directly with the WHO SMART Guidelines, the machine-readable versions of the WHO’s clinical and public health recommendations. This connection is important in practice: it means that the systems that countries build on Open Health Stack are already capable of providing WHO quality-assured content and that no separate work is required to translate WHO guidelines into a usable form.
Impact on countries
The Foundation will maintain and expand open source code libraries, developer tools and reference software that any country or implementing partner can use, with no licensing costs and no vendor lock-in. This is the kind of common, reusable foundation that will help countries move toward what the WHO calls Resilient Essential Digital and Data Health Infrastructure (REDDHI): a state in which a country’s essential digital health services and applications, such as shared registries, a lifelong health record, and standards-based exchanges between systems, are technically and financially sustainable on their own terms. Open, community-maintained code based on open standards, open technologies, open architectures and open content, the “Full-STAC” approach, is part of what enables this sustainability, rather than requiring countries to rebuild or re-license the same basic capabilities over and over again.
Because the code is open and standards-based, countries and local companies can build on it, customize it and maintain it themselves, rather than depending on a single provider. This is central to the shift called for in the Accra Action Plan and the Lusaka Agenda: away from externally provided point solutions and towards in-country systems that can sustain local technology ecosystems both technically and financially over the long term. It also supports the local production of digital health capabilities, strengthening the developers, companies and public institutions in the countries that will maintain these systems in the coming years, rather than relying on remote software sources and external support.
Prepare countries for verifiable AI
The Foundation also includes AI Commons for Global Health, a neutral, model-agnostic space developed jointly with WHO to develop the shared tools required for safe and effective AI in healthcare, including common technical protocols, health-specific capabilities that AI systems can draw on, and assessment and benchmarking tools. By building on open standards for AI and enabling SMART guidelines on FHIR as part of the ecosystem, it will provide countries with a practical way to integrate AI into their health systems on an infrastructure that is interoperable, verifiable and based on WHO standards, rather than introducing AI tools that deviate from or are inconsistent with the standards on which their health systems already depend.
Garrett Mehl, Head of the Digital Health and Information Systems Division at WHO, explains: “We have seen too many promising digital health systems collapse when the donor project that funded them ended. The path to resilient national digital health ecosystems lies through countries’ ownership of both the governance and technical foundations of their systems; governance they control, standards against which they can test, and software for which they are not constantly dependent on external providers to maintain. The Open Health Stack Software Foundation is a crucial part of this infrastructure for independence: open, managed by the community, not owned by a single actor and designed to last through each funding cycle.”
How countries and their partners can benefit
For health ministries and their technology partners, the practical opportunity is to build on tools that already meet WHO standards, rather than starting from scratch or committing to a single vendor. WHO SMART Guidelines, the WHO’s machine-readable clinical and public health content, are freely available at smart.who.int, and the free open source code, developer tools and reference software that implement this content in real-world systems are available at ohs.foundation.
Joining the Foundation is free for non-profit, academic and government institutions, consistent with the Linux Foundation’s Associate membership level. Country technical teams and local implementing partners can contribute to and leverage the Code by building it into national digital health systems, adapting it to local needs, and self-maintaining it over time. This creates permanent technical capacities on site and eliminates recurring dependency on external providers and systems.
https://www.who.int/news/item/09-07-2026-who-joins-the-open-health-stack-software-foundation-to-advance-open–standards-based-digital-health-for-all-countries
